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Published on: February 25, 2016
A structural equation model of the developmental origins of blood pressure
D L Dahly1, L S Adair, K A Bollen
1Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA. dahly@email.unc.edu
Insights
Maternal height and arm fat area influence fetal development, impacting birth weight positively and systolic blood pressure inversely in young adulthood. This study refines understanding of fetal environment effects.
Area of Science:
- Public Health
- Human Development
- Epidemiology
Background:
- Birth size is an inadequate proxy for the fetal environment.
- Existing regression models for birth size and blood pressure lack robustness.
Purpose of the Study:
- To model the fetal environment as a latent variable.
- To assess the association between the latent fetal environment (LFE) and systolic blood pressure (SBP).
- To control for birth weight (BW) and current weight (CW) in the analysis.
Main Methods:
- Structural equation modeling (SEM) was employed.
- Maternal height and arm fat area (AFA) determined the latent fetal environment (LFE).
- Data from 2653 young adult Filipinos (mean age 21) from the Cebu Longitudinal Health and Nutrition Survey were analyzed.
Main Results:
- The SEM model demonstrated excellent fit.
- An inverse relationship was observed between LFE and SBP in both males and females.
Conclusions:
- Maternal height and AFA positively influence fetal growth (BW).
- Maternal height and AFA are inversely associated with young adult SBP.
- These findings support the hypothesis on fetal environment's impact on long-term health outcomes.
Background:
Birth-size is a problematic proxy for the fetal environment, and regression models testing for associations between birth-size and blood pressure have been criticized.
Methods:
We modelled fetal environment as a latent variable determined by maternal height and arm fat area (AFA) during pregnancy using structural equation modelling. We tested for associations between latent fetal environment (LFE) and systolic blood pressure (SBP) while controlling for birth weight (BW) and current weight (CW). Data are from 1435 male and 1218 female young adult Filipinos (2005; mean age 21 years) enrolled in the Cebu Longitudinal Heath and Nutrition Survey, an ongoing, community-based study of a one-year birth cohort. Using AMOS 6.0, LFE was modelled as a determinant of BW, CW and SBP; CW was modelled as a determinant of SBP.
Results:
Overall model fit was excellent (chi2: 32.14, 27 df, P=0.23). The estimated direct relationship between LFE and SBP was inverse for both males ((-0.43) -0.26 (-0.10)) and females ((-0.29) -0.18 (-0.07)).
Conclusions:
These results are consistent with the hypothesis that maternal height and AFA impact fetal development in a manner that is positively associated with fetal growth (as reflected by BW) and inversely associated with SBP in young adulthood.
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